Abstract 17756: Do Biventricular Mechanics in Transient Constrictive Pericarditis Improve After Medical Therapy?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ayman I Ayache ◽  
Kenya Kusunose ◽  
Hussain A Ismaeel ◽  
Muhammad Tariq ◽  
Deborah H Kwon ◽  
...  
Keyword(s):  
Constrictive Pericarditis ◽  
Myocardial Strain ◽  
Strain Improvement ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Myocardial Mechanics ◽  
Anterolateral Wall ◽  
Anti Inflammatory ◽  
Myocardial Strain Imaging

Introduction: Reversible constrictive pericarditis (CP) has been described with resolution of constriction after treatment with anti-inflammatory medications. In our study, we assessed the improvement of biventricular myocardial strain in CP patients treated medically compared to CP patients who underwent pericardiectomy. Methods and Results: We compared myocardial mechanics by 2-dimensional speckle tracking in 16 CP patients (age: 56±13; 75% males) who received anti-inflammatory medications to an age and sex matched CP group (age: 57±12; 75% males) who underwent pericardiectomy. At baseline, both treatment groups had depressed left ventricular (LV) anterolateral wall strain (LWS) and right ventricular (RV) free wall longitudinal systolic strain (FWS) but preserved LV septal wall systolic strain (SWS). In a median follow-up of 150 days the medically treated patients showed improvement of the depressed LVLWS/LVSWS (Pre: 0.61±0.17, Post: 0.89±0.21;P<0.001) and a trend in RVFWS/LVSWS (Pre:0.66±0.45, Post:0.89±0.38;P=0.12), that is similar to the improvement of the depressed LVLWS/LVSWS (Pre: 0.85±0.12, Post: 0.92±0.1;P<0.05) and trend in RVFWS/LVSWS (Pre: 0.77±0.32, Post: 0.86±0.18;P=0.09) of post pericardiectomy patients at a median follow-up of 74 days. Conclusions: Biventricular myocardial strain imaging is a robust technique for assessment of response to anti-inflammatory therapy in CP patients. Medical treatment of CP leads to systolic strain improvement that is more pronounced in the LV and RV free walls, hence having similar impact on the biventricular myocardial mechanics as pericardiectomy.

Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis

Heart ◽  
2021 ◽  
pp. heartjnl-2020-317304
Author(s):  
Kimi Sato ◽  
Ayman Ayache ◽  
Arnav Kumar ◽  
Paul C Cremer ◽  
Brian Griffin ◽  
...  
Keyword(s):  
Constrictive Pericarditis ◽  
Clinical Symptoms ◽  
Heart Association ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Clinical Resolution ◽  
Ventricular Mechanics ◽  
Anti Inflammatory ◽  
The Impact

ObjectivePatients with constrictive pericarditis (CP) with active inflammation may show resolution with anti-inflammatory therapy. We aimed to investigate the impact of anti-inflammatory medications on constrictive pathophysiology using echocardiography in patients with CP.MethodsWe identified 35 patients with CP who were treated with anti-inflammatory medications (colchicine, prednisone, non-steroidal anti-inflammatory drugs) after diagnosis of CP (mean age 58±13; 80% male). Clinical resolution of CP (transient CP) was defined as improvement in New York Heart Association class during follow-up. We assessed constrictive pathophysiology using regional myocardial mechanics by the ratio of peak early diastolic tissue velocity (e’) at the lateral and septal mitral annulus by tissue Doppler imaging (lateral/septal e’) or the ratio of the left ventricular lateral and septal wall longitudinal strain (LSlateral/LSseptal) by two-dimensional speckle-tracking echocardiography. Longitudinal data were analysed using a mixed effects model.ResultsDuring a median follow-up of 323 days, 20 patients had transient CP, whereas 15 patients had persistent CP. Transient CP had higher baseline erythrocyte sedimentation rates (ESR) (p=0.003) compared with persistent CP. There were no significant differences in LSlateral/LSseptal and lateral/septal e’. During follow-up, only transient CP showed improvement in lateral/septal e’ (p<0.001) and LSlateral/LSseptal (p=0.003), and recovery of inflammatory markers was similar between the two groups. In the logistic model, higher baseline ESR and greater improvement in lateral/septal e’ and LSlateral/LSseptal were associated with clinical resolution of CP using anti-inflammatory therapy.ConclusionsImprovement of constrictive physiology detected by lateral/septal e’ and LSlateral/LSseptal was associated with resolution of clinical symptoms after anti-inflammatory treatment. Serial monitoring of these markers could be used to identify transient CP.

scholarly journals 1029 Anthracycline and trastuzumab-induced subclinical cardiac damage and its prevention in the SAFE trial. Myocardial strain imaging and 3D echo interim analysis data

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Barletta ◽  
L Livi ◽  
F Martella ◽  
I Desideri ◽  
F Venditti ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Interim Analysis ◽  
Myocardial Strain ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Controlled Study ◽  
3D Echo ◽  
One Year ◽  
Myocardial Strain Imaging

Abstract Background Benefit of anthracyclines and trastuzumab therapies on disease-free survival in breast cancer is well known. Cardiotoxicity is a feared potential complication of both drugs. It usually progresses from cardiomyocyte injury to silent left ventricular dysfunction (LVD) which often becomes symptomatic and irreversible. Therefore, its prevention and early detection are of paramount importance in these cancer patients. Purpose SAFE trial (CT registry ID: NCT2236806) is a randomized phase 3, four-arm, single-blind, placebo-controlled study that aims to evaluate the effects of Bisoprolol (B) (5 mg, twice daily), Ramipril (R) (5 mg, twice daily) or the combination of the two (R + B), compared to placebo (P), on subclinical heart heart damage. Interim data of left ventricular function monitored with 3D Echo and Myocardial Strain Imaging are presented. Methods Out of 225 patients asked to participate, 191 were enrolled (mean age 48.9 ± 9.0 years). Follow-up monitoring (at 3, 6, 12 months[m]) comprised 3D ejection fraction (3D-LVEF) and Global Longitudinal Strain (GLS). One patient had sub-acute anthracyclines cardiotoxicity. Data at one year of 123 patients were available (34 P, 28 R, 31 B, 30 R + B). Results At time 0, no significant differences in age, body mass index, hemodynamic parameters were observed among arms. Data of 3D-LVEF and GLS at time 0 and during follow-up are reported in the figure (p level versus time 0 – GLS repeated measures). There was a significant reduction in 3D LVEF and increase in GLS in P arm (3D LVEF: 3m: -3.3%, 6m: - 5.2%, 12m: -3.7%; GLS: 3m: +5,7%, 6m: +7.8%, 12m: + 7,1%). A similar, though less significant, worsening of 3D LVEF (-2.4%,-1.9%,-2.2% at 3, 6, 12m, respectively) and GLS (+2.7%, +3.2% at 3 and 6m, respectively) was found in R arm. In B and B +R arms there was a worsening at 6m (3D LVEF -2.5%, GLS +2.7%), whereas at 12m only GLS increased (+3.2%) in B, not in B + R. Arm differences were significant (repeated measures two ways) both for 3D LVEF (two-way repeated measures ANOVA, p level = 0.038, observed power 0.855) and GLS (p level = 0.002, observed power 0.973). Conclusions This interim analysis of the SAFE trial shows that demonstration of subclinical cardiotoxicity is feasible with 3D echo and myocardial strain imaging. Significant subclinical damage potentially leading to LVD is present at one year. Both B alone on in combination with R may be a successful cardioprotective strategy in patients treated with anthracyclines and trastuzumab. Abstract 1029 Figure. Time course of GLS and 3D LVEF

Abstract 17184: CMR Derived Myocardial Mechanics in Patients With Systemic Sarcoidosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Veronica Rolim S. Fernandes ◽  
Beatriz Jauregui Garrido ◽  
Maria E Siqueira ◽  
Jonathan Katz ◽  
Adam Jacobi ◽  
...  
Keyword(s):  
Myocardial Dysfunction ◽  
Myocardial Strain ◽  
Prognostic Significance ◽  
Cardiac Mechanics ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Myocardial Mechanics ◽  
Systemic Sarcoidosis ◽  
Lv Ejection Fraction

Objective: To assess myocardial mechanics by cardiac magnetic resonance (CMR)-derived strain in patients with biopsy-proven systemic sarcoidosis. Methods: We included 50 consecutive patients (age 51 ± 11 years old, 30 males) with biopsy-proven systemic sarcoidosis who underwent gadolinium-enhanced CMR for suspected cardiac sarcoid involvement. Late gadolinium enhancement (LGE) was considered positive if showing an intramyocardial/subepicardial location with a nonischemic pattern. From cine images and using dedicated software (TomTec©), we quantified mean left ventricular (LV) longitudinal, radial, and circumferential peak strains as the average of 16 standard myocardial segments. We also randomly selected from our database 15 control subjects without structural heart disease (age 41 ± 11 years old, 5 males). Results: Both mean longitudinal strain (LS) and LV ejection fraction (LVEF) were lower in sarcoid patients than controls (-11.8 ± 7.3% vs. -18.1 ± 3.9%, p55%, n=32) mean LS was reduced compared to controls (-12.2 ± 7.8% vs. -18.1 ± 3.9% respectively, p=0.01; Fig 1B). There was no correlation between LVEF and mean LS (r=-0.11, p=0.65). We found no significant differences in circumferential or radial strains. LGE was present in 16 patients (32%). Sarcoid patients with LGE showed significantly less mean LS than those without (-8.5 ± 8.4% vs. -13.6 ± 6.4%, p<0.001; Fig 1A) although LVEF did not differ significantly (52% vs. 59%, p=0.35). No significant differences in circumferential or radial strains were found. Conclusions: In patients with systemic sarcoidosis, evaluation of cardiac mechanics with CMR detects myocardial dysfunction even in the presence of preserved LVEF. This is more pronounced in patients with positive LGE. The potential diagnostic and prognostic significance of CMR-derived myocardial strain in sarcoidosis deserves further investigation.

External Reshaping of the Left Ventricle in Off-Pump Surgery

2006 ◽  
Vol 1 (4) ◽  
pp. 155-159
Author(s):  
Sotirios N. Prapas ◽  
Demetrios A. Protogeros ◽  
Vassilios N. Kotsis ◽  
Ioannis A. Panagiotopoulos ◽  
Ioannis P. Raptis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Bypass Graft ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Off Pump ◽  
Anterolateral Wall

Background Dyskinetic areas of the lateral and inferior left ventricular (LV) wall are frequently encountered in patients with coronary artery disease. In clinical practice, all of the techniques described for the restoration of shape and function of the LV require cardiopulmonary bypass. A new technique of LV external reshaping that aims to obtain a near-normal ventricular conical shape is described. This technique is performed during an off-pump coronary artery bypass graft (CABG) operation. It is used mainly on the inferior and lateral walls of the ventricle, but also on the anterolateral wall when warranted. This technique can be considered an alternative to classic aneurysmectomy in high-risk cases. Methods All patients underwent total arterial revascularization without aortic manipulation. Intraoperative transesophageal echocardiography was used in all cases to define the dilated akinetic/dyskinetic area. This area was effectively plicated using interrupted mattress sutures reinforced with Teflon felt or pericardial strips. This technique allows near normalization of the geometry of the ventricle and LV end-diastolic volume reduction. In cases of preexisting mitral regurgitation (MR), a reduction of the MR was observed after lateral wall restoration. From September 2002 to April 2005, the external reshaping technique was applied on 56 cases among 949 off-pump CABG cases (5.9%). A detailed transthoracic echocardiogram was obtained preoperatively. The mean ejection fraction of all enrolled patients was 31.2 ± 7%. The location of the plication was: lateral wall in 22, inferior wall in 16, and anterolateral wall in 18. The average number of coronary anastomoses was 2.6. Twelve patients were found to have 2–3 + MR. All patients were followed up during a period of 35 months. Results One patient died due to severe right ventricular dysfunction. Seven patients developed atrial fibrillation, and one had ventricular tachycardia. During the follow-up period, we observed a reduction of left ventricular end-diastolic diameter and a parallel augmentation of ejection fraction (mean 42.2 ± 4%). The ventricular cavity's architecture was normalized. Among the 12 patients with MR, an improvement of regurgitation was noted in 10 (from 2–3+ to 1–2+). One patient died during the follow-up period, and 1 patient required reoperation due to persistent severe MR. Conclusions The external reshaping of the LV during beating heart surgery is technically feasible, has promising results, and can be performed without major complications.

Long-term natural history of transient constrictive pericarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Ramchand ◽  
J Chahine ◽  
H Alnajjar ◽  
M Chetrit ◽  
P Cremer ◽  
...  
Keyword(s):  
Natural History ◽  
Constrictive Pericarditis ◽  
Inflammatory Markers ◽  
Diuretic Therapy ◽  
Delayed Enhancement ◽  
Duration Of Symptoms ◽  
History Of ◽  
Anti Inflammatory

Abstract Background In recent years, there has been increasing recognition of a potentially-reversible, transient/ subacute form of constrictive pericarditis (CP). To date, studies have been small with lack of long-term longitudinal follow-up. Purpose We aimed to elucidate the causes and natural history of subacute CP. Methods Patients were included if (1) they had a diagnosis of CP, (2) had cardiac magnetic resonance (CMR) within 12 months of symptom onset with evidence of pericardial delayed enhancement/ inflammation (Figure) (3) received anti-inflammatory medications. Results A total of 78 individuals were included, comprising 61 men (78%) with a mean age of 59±14 years. Causes of subacute CP included idiopathic/ viral pericarditis (58%), post-pericardiotomy (29%), autoimmune (6%), radiation therapy (3%) and others (4%). After median follow-up of 4.4 years, 31 (40%) required pericardiectomy. There were no deaths. Patients who underwent pericardiectomy had longer duration of symptoms at presentation [6 (4–9) vs. 3 (2–5) months, P&lt;0.01], were more likely to be on diuretic therapy (87 vs. 45%, P&lt;0.001), had lower ultra-sensitive C-reactive protein [4.4 (2.6–13.1) vs. 11.95 (1.8–61.55) mg/dl, P&lt;0.001] and lower erythrocyte sedimentation rate [5 (2–10) vs. 25 (6–43 mm/hr), P=0.031] compared to those who were managed medically. There were no other significant differences in clinical characteristics or baseline anti-inflammatory therapy. The presence of elevated inflammatory markers (HR: 0.18; 95% CI: 0.06–0.58, P&lt;0.01) was an independent predictor of freedom from pericardiectomy after adjustment for relevant clinical and imaging parameters. Conclusions We present the original observations of the largest cohort of patients with transient CP to date and demonstrate that increased inflammatory markers were independently associated with long-term freedom from pericardiectomy. Our results suggest that a trial of anti-inflammatory therapy in the setting of elevated inflammatory markers may be appropriate prior to referral for surgery given the possible reversibility. Pericardial delayed enhancement Funding Acknowledgement Type of funding source: None

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